Intensity of Antianginal Therapy Before PCI Not Associated With Lower PCI Rates

Aug 15, 2013

ACC News Story

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There is no association between the intensity of antianginal therapy given in the two weeks prior to percutaneous coronary intervention (PCI) in a given region of the country and the rates of PCI in patients with stable coronary artery disease in that region. Further, there are relatively low rates of intensive therapy of two or more antianginal medications in this patient population.

The study, published in Circulation Cardiovascular Interventions
, examined data from the CathPCI Registry® on patients undergoing PCI for stable coronary artery disease from 2009 through 2011 in regions across the U.S. and compared the antianginal therapy rates with PCI rates in the Dartmouth Atlas of Cardiovascular Health Care. They also analyzed the percentage of these patients who received two or more antianginal medications (b-blockers, long-acting nitrates, calcium channel blockers or ranolazine) in the two weeks before PCI.
Among the 300,772 PCI procedures the researchers identified, 32.8 percent of patients received no antianginal medications, 48.3 percent received one antianginal drug, 16.1 percent received two drugs, and 2.8 percent received three or more antianginal medications. Nearly 60 percent of the patients received b-blockers.

The patients receiving two or more antianginal medications before PCI had more symptoms, were older, had more comorbid conditions, were more likely to be receiving Medicare and were less likely to be current or recent smokers.

Contrary to their hypothesis that more intensive use of antianginal medications would be associated with lower PCI rates, the investigators found no association between the use of two or more antianginal medications before PCI and the actual rates of PCI in the Dartmouth Atlas (p = 0.64). They found regions of the country with high antianginal therapy rates and low PCI rates, but also regions with high rates of antianginal therapy and high PCI rates.

“The rates of antianginal medications varied widely across the U.S. with no correlation to the rates of PCI, yet a significant proportion of regions provided both high degrees of antianginal therapy and lower rates of PCI, suggesting that understanding these practice patterns could provide insights into higher-quality health care,” the study’s authors wrote.
“Collectively, the low rates in providing ≥2 antianginal medications before PCI suggest an important opportunity to ensure that maximal medical therapy is attempted before proceeding to PCI,” they noted.